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Original Research: COPD |

Advantages of Endurance Treadmill Walking Compared With Cycling To Assess Bronchodilator Therapy

Xiaolei Zhang, MD, PhD; Laurie A. Waterman, MS; Joseph Ward, RCPT; John C. Baird, PhD; Donald A. Mahler, MD, FCCP
Author and Funding Information

From the Pulmonary and Critical Care Department (Dr Zhang), Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; the Pulmonary Function and Cardiopulmonary Exercise Laboratories (Ms Waterman, Mr Ward), Dartmouth-Hitchcock Medical Center, and the Section of Pulmonary and Critical Care Medicine (Drs Baird and Mahler), Dartmouth Medical School, Lebanon, NH; and Psychological Applications (Dr Baird), South Pomfret, VT.

Correspondence to: Donald A. Mahler, MD, FCCP, Section of Pulmonary and Critical Care Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03756-0001; e-mail: donald.a.mahler@hitchcock.org


Funding/Support: This study was supported by Sepracor, Inc. [Grant ASRC340 C].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(6):1354-1361. doi:10.1378/chest.09-2470
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Background:  Walking is a familiar daily activity that is generally limited by breathlessness, whereas cycling is an uncommon physical effort typically limited by leg discomfort. The hypothesis was that patients with COPD would exhibit greater improvements in exercise endurance and relief of breathlessness with bronchodilator therapy during treadmill walking compared with cycling.

Methods:  In this randomized, 2 × 2, double-blind, placebo-controlled, crossover trial, 20 patients with COPD (age, 64 ± 7 years; FEV1, 56 ± 14% predicted) performed constant-load endurance exercise on the treadmill and cycle ergometer at 85% of capacity after inhaling normal saline (NS) or arformoterol (ARF) (15 μg).

Results:  Increases in endurance times and consistency of responses were greater with treadmill walking (Δ: 157 ± 286 s; P = .024; 80% improved) than with cycle exercise (Δ: 110 ± 219 s; P = .038; 65% improved) with ARF compared with NS. However, these changes were not significantly different. The slope of breathlessness-time (mean Δ = −29%; P = .007) and the magnitude of oxygen desaturation were significantly lower with ARF compared with NS during treadmill, but not cycle, exercise. Inspiratory capacity values were similar between modes of exercise when comparing the same study medication.

Conclusions:  Improved endurance times support both constant-load treadmill and cycle exercise to assess the efficacy of bronchodilator therapy in patients with COPD. Unique differences in physiologic and perceptual responses with bronchodilation demonstrate advantages of treadmill walking as an exercise stimulus.

Trial Registration:  clinicaltrials.gov; Identifier: NCT00754546.

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